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Dysmenorrhea (Holistic)

About This Condition

A woman’s monthly cycle may include several days of pain and discomfort due to cramps, also known as dysmenorrhea. How do you find relief? According to research or other evidence, the following self-care steps may be helpful.

Mix in magnesium

Take a supplement containing 360 mg a day of this essential mineral to help keep uterine muscles relaxed

Don’t forget the fish oil

Take a supplement containing 1,800 mg a day of EPA and DHA to help prevent menstrual symptoms

Take vitamin E in advance

To help prevent severe pain, take 400 to 600 IU of vitamin E a day for five days, beginning two days before menstruation

Make time for a checkup

See your healthcare provider to find out if your dysmenorrhea could be caused by a treatable medical condition

About

About This Condition

Dysmenorrhea is painful menstruation. It is classified as either primary or secondary. Primary
dysmenorrhea generally occurs within a couple of years of the first menstrual period. The pain tends to
decrease with age and very often resolves after childbirth. Secondary dysmenorrhea is menstrual pain caused
by another condition, commonly endometriosis. It starts later in
life and tends to increase in intensity over time.

As many as half of menstruating women are affected by dysmenorrhea, and of these, about 10% have severe
dysmenorrhea, which greatly limits activities for one to three days each month.1

Symptoms

Dysmenorrhea includes symptoms of abdominal bloating, frequent and intense cramps, pain below the waistline, or a dull ache that may radiate to the lower back or legs. There may also be symptoms of headache, nausea, diarrhea or constipation, frequent urination, and, occasionally, vomiting. The symptoms usually occur just before or during the menstrual period.

Healthy Lifestyle Tips

Many women feel the need to lie still while experiencing menstrual cramps, while others find that exercise helps relieve the pain of dysmenorrhea. This variation from woman to woman may explain why some researchers report that exercise makes symptoms worse,2 though most studies report that exercise appears helpful.3

Holistic Options

Relaxation techniques have been used with some success to alleviate dysmenorrhea in some young women. According to one preliminary study, the symptoms of menstrual cramps, nausea, irritability, and poor concentration greatly improved after 20-minute relaxation sessions twice per week.4

Acupuncture may be a useful therapy in the treatment of dysmenorrhea. A preliminary trial reported that 86% of women treated with acupuncture for dysmenorrhea had complete cessation of pain for three consecutive menstrual periods.5 Other preliminary trials have demonstrated similar results.6, 7, 8 A controlled clinical trial reported 91% efficacy with acupuncture compared to 36.4% efficacy with sham acupuncture (using fake acupuncture points) and 18% efficacy in an untreated control group.9 A small trial compared a 30-minute TENS (transcutaneous electrical nerve stimulation) treatment to stimulate acupuncture points with a placebo pill for dysmenorrhea. There was a large placebo effect in this study, and pain relief over the next several hours was not significantly better in the treatment group compared to placebo.10 More controlled trials are needed to determine whether acupuncture is a useful treatment for dysmenorrhea.

Spinal manipulation has been investigated as a treatment for dysmenorrhea. One small preliminary study reported improvement in symptoms measured by a questionnaire.11 A controlled clinical trial compared a single treatment of spinal manipulation to the low back and pelvis to a sham manipulation that was designed to be ineffective. Women receiving real manipulation reported twice as much relief as those receiving sham treatment.12 A recent, larger trial repeated the above study, testing a series of treatments over two months. Women reported less pain from both real and sham treatment, but there was no difference between the groups.13 Whether there is a real benefit from spinal manipulation for women with dysmenorrhea remains unclear at this time.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation

Why

Avoid alcohol

Some physicians advise that avoiding alcohol, because it depletes stores of certain nutrients and alters carbohydrate metabolism—which in turn might worsen muscle spasms.

Some physicians advise that alcohol should be avoided by women experiencing menstrual pain, because it depletes stores of certain nutrients and alters the metabolism of carbohydrates—which in turn might worsen muscle spasms. Alcohol can also interfere with the liver’s ability to metabolize hormones. In theory, this might result in elevated estrogen levels, increased fluid and salt retention, and heavier menstrual flow.

Supplements

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by some in the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

1 StarFor an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement

Why

3 Stars

Magnesium

360 mg daily

Supplementing with magnesium may help keep uterine muscles relaxed.

Magnesium plays a role in controlling muscle tone and could be important in preventing menstrual cramps.14, 15 Magnesium supplements have been reported in preliminary and double-blind European research to reduce symptoms of dysmenorrhea.16, 17, 18 In one of these double-blind trials, women took 360 mg per day of magnesium for three days beginning on the day before menses began.19

2 Stars

Fish Oil

Refer to label instructions

A fish oil supplement containing EPA and DHA may help prevent menstrual syndromes.

Diets low in omega-3 fatty acids (EPA and DHA) have been associated with menstrual pain.20 In one double-blind trial, supplementation with fish oil, a good source of omega-3 fatty acids, led to a statistically significant 37% drop in menstrual symptoms. In that report, adolescent girls with dysmenorrhea took an unspecified amount of fish oil that provided 1,080 mg of EPA and 720 mg of DHA per day for two months to achieve this result.21 A double-blind trial found that the same amount of EPA and DHA plus 7.5 mcg per day of vitamin B12 led to a greater than 50% decrease in menstrual symptoms, but a group taking only fish oil did not obtain as much relief.22 Six grams of fish oil per day provides the approximate levels of EPA and DHA used in these trials. In another double-blind trial, 1 gram per day of fish oil significantly decreased pain intensity, compared with a placebo, in women with dysmennorhea.[REF]

2 Stars

Ginger

250 mg four times per day, beginning at the start of menstruation and continuing for three days

In a double-blind trial, ginger powder was as effective as anti-inflammatory medication (mefenamic acid and ibuprofen) in relieving symptoms of dysmenorrhea.

Ginger has been used in some systems of traditional medicine to treat dysmenorrhea. In a double-blind trial, ginger powder was as effective as anti-inflammatory medication (mefenamic acid and ibuprofen) in relieving symptoms of dysmenorrhea. Ginger was used in the amount of 250 mg four times per day, beginning at the start of menstruation and continuing for three days.23

2 Stars

Krill Oil

2 grams daily for one month; after that, 2 grams per day beginning eight days prior to menstruation and continuing for two days after the start

Women who took krill oil had improved abdominal pain and reported using fewer pain relievers for menstrual pain than those who took fish oil in one study.

In a double-blind trial, women with PMS took 2 grams of either krill oil from Antarctic krill (a zooplankton crustacean) or fish oil for one month, followed by two months in which the women took their supplement beginning eight days prior to menstruation and continuing for two days after the start of menstruation. While abdominal pain symptoms were similarly reduced by either oil, those taking krill oil reported using fewer pain relievers for menstrual pain.24

2 Stars

Pycnogenol

60 mg per day

Preliminary research and double-blind research has reported that pycnogenol may reduce severe abdominal and back pain during menses.

Preliminary research reported that 60 mg Pycnogenol twice daily for two months reduced abdominal and back pain during menses.25 A double blind trial by the same researchers using 60 mg Pycnogenol per day confirmed these findings for women with more severe pain, but not for those whose menstrual pain was mild.26

2 Stars

Vitamin B3 (Niacin)

200 mg daily throughout menstrual cycle; for cramps: 100 mg every two to three hours

The niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women supplementing with it throughout the menstrual cycle.

The niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women taking 200 mg of niacin per day throughout the menstrual cycle. They then took 100 mg every two or three hours while experiencing menstrual cramps.27 In a follow-up study, this protocol was combined with 300 mg of vitamin C and 60 mg of the flavonoid rutin per day, which resulted in a 90% effectiveness for relieving menstrual cramps.28 Since these two preliminary studies were published many years ago, no further research has explored the relationship between niacin and dysmenorrhea. Niacin may not be effective unless taken for seven to ten days before the onset of menstrual flow.

Supplementing with a combination of vitamin B3, vitamin C, and the flavonoid rutin resulted in a 90% effectiveness for relieving menstrual cramps in one study.

The niacin form of vitamin B3 has been reported to be effective in relieving menstrual cramps in 87% of a group of women taking 200 mg of niacin per day throughout the menstrual cycle.29 They then took 100 mg every two or three hours while experiencing menstrual cramps.30 In a follow-up study, this protocol was combined with 300 mg of vitamin C and 60 mg of the flavonoid rutin per day, which resulted in a 90% effectiveness for relieving menstrual cramps. Since these two preliminary studies were published many years ago, no further research has explored the relationship between niacin and dysmenorrhea. Niacin may not be effective unless taken for seven to ten days before the onset of menstrual flow.

2 Stars

Vitamin E

400 to 600 IU of vitamin E a day for five days, beginning two days before menstruation

Taking vitamin E beginning two days before menstruation may help prevent severe pain.

In a double-blind trial, supplementation with 500 IU of vitamin E per day for two months, beginning two days before menstruation and continuing for three days after the onset of menstruation, was significantly more effective than a placebo at relieving menstrual pain.31 Similar benefits were seen in four-month double-blind trial using 400 IU per day, beginning two days before the expected start of menstruation and continuing through the first three days of bleeding.32

1 Star

Açaí

Refer to label instructions

Açaí is a traditional remedy for dysmenorrhea, and there is preliminary evidence that some anthocyanins found in açaí may help with dysmenorrhea symptoms.

Açaí is reported to be a traditional remedy for dysmenorrhea. There is preliminary evidence that anthocyanins from bilberry, some of which are also found in açaí, may help with dysmenorrhea symptoms.33 However, there have been no clinical trials investigating açaí’s effect on dysmenorrhea.

1 Star

Black Cohosh

Refer to label instructions

Black cohosh has a history as a folk medicine for relieving menstrual cramps.

Black cohosh has a history as a folk medicine for relieving menstrual cramps. Black cohosh can be taken in several forms, including crude plant, dried root, or rhizome (300–2,000 mg per day), or as a solid, dry powdered extract (250 mg three times per day). Standardized extracts of the herb are available, though they have primarily been researched for use with menopausal women suffering from hot flashes. The recommended amount is 20–40 mg twice per day.34 The best researched form provides 1 mg of deoxyactein per 20 mg of extract. Tinctures can are also used (2–4 ml three times per day).35 The Commission E Monograph recommends black cohosh be taken for up to six months, and then discontinued.36

1 Star

Blue Cohosh

Refer to label instructions

Blue cohosh has been used traditionally for easing painful menstrual periods. Women of childbearing age using this herb should stop using it as soon as they become pregnant.

Blue cohosh, although unrelated to black cohosh, has also been used traditionally for easing painful menstrual periods. Blue cohosh, which is generally taken as a tincture, should be limited to no more than 1–2 ml taken three times per day. The average single application of the whole herb is 300–1,000 mg. Blue cohosh is generally used in combination with other herbs. Women of childbearing age using this herb should cease using it as soon as they become pregnant—the herb was shown to cause heart problems in an infant born following maternal use of blue cohosh.37

1 Star

Calcium

Refer to label instructions

Muscles that are calcium-deficient tend to be hyperactive and therefore might be more likely to cramp. Calcium may help prevent menstrual cramps by maintaining normal muscle tone.

In theory, calcium may help prevent menstrual cramps by maintaining normal muscle tone. Muscles that are calcium-deficient tend to be hyperactive and therefore might be more likely to cramp. Calcium supplementation was reported to reduce pain during menses in one double-blind trial,38 though another such study found that it relieved only premenstrual cramping, not pain during menses.39 Some doctors recommend calcium supplementation for dysmenorrhea, suggesting 1,000 mg per day throughout the month and 250–500 mg every four hours for pain relief, during acute cramping (up to a maximum of 2,000 mg per day).

1 Star

Corydalis

Refer to label instructions

A constituent of corydalis called tetrahydropalmatine appears to heave pain-relieving and sedative effects. It has shown to be effective for painful menstruation.

Corydalis contains several alkaloids, and one called tetrahydropalmatine (THP) is considered to be the most potent. In laboratory research, THP has been shown to exhibit a wide number of pharmacological actions on the central nervous system, including pain-relieving and sedative effects.40 According to a secondary reference, painful menstruation responded favorably to the administration of THP.41 For a pain-relieving effect, the recommended amount for the crude dried rhizome is 5–10 grams per day. Alternatively, one can take 10–20 ml per day of a 1:2 extract.

1 Star

Cramp Bark

Refer to label instructions

Cramp bark has been a favorite traditional herb for menstrual cramps. It may help ease severe cramps that are associated with nausea, vomiting, and sweaty chills.

Cramp bark (Viburnum opulus) has been a favorite traditional herb for menstrual cramps, thus its signature name. Cramp bark may help ease severe cramps that are associated with nausea, vomiting, and sweaty chills. Research from animal studies shows that cramp bark blocks spasms of smooth muscle.42 Cramp bark is traditionally prepared by placing two teaspoons of the dried bark into a cup of water and bringing it to a boil; it is then simmered gently for 10 to 15 minutes. The tea may be drunk three times per day.43 Alternatively, 4–8 ml of tincture may be used three times per day.

1 Star

Dong Quai

Refer to label instructions

Dong quai has been used either alone or in combination with other traditional Chinese medicine herbs to help relieve painful menstrual cramps.

Dong quai has been used either alone or in combination with other Traditional Chinese Medicine herbs to help relieve painful menstrual cramps. Many women take 3–4 grams per day. A Japanese herbal formulation known as toki-shakuyaku-san combines peony root (Paeonia spp.) with dong quai and four other herbs and has been found to effectively reduce symptoms of cramping and pain associated with dysmenorrhea.44

1 Star

False Unicorn

Refer to label instructions

False unicorn was used in the Native American tradition for a large number of women’s health conditions, including painful menstruation.

False unicorn was used in the Native American tradition for a large number of women’s health conditions, including painful menstruation. Generally, false unicorn root is taken as a tincture (2–5 ml three times per day). The dried root may also be used (1–2 grams three times daily). It is typically taken in combination with other herbs supportive of the female reproductive organs.

1 Star

Peony

Refer to label instructions

An herbal formulation known as toki-shakuyaku-san combines peony root with other herbs and has been found to reduce cramping and pain associated with dysmenorrhea.

Dong quai has been used either alone or in combination with other Traditional Chinese Medicine herbs to help relieve painful menstrual cramps. Many women take 3–4 grams per day. A Japanese herbal formulation known as toki-shakuyaku-san combines peony root (Paeonia spp.) with dong quai and four other herbs and has been found to effectively reduce symptoms of cramping and pain associated with dysmenorrhea.45

1 Star

Progesterone

Refer to label instructions

Some practitioners report success using topical progesterone cream for dysmenorrhea.

Vervain is a traditional herb for dysmenorrhea, however there is no research to validate this use. Tincture has been recommended at an amount of 5–10 ml three times per day.

1 Star

Vitamin B1

Refer to label instructions

Vitamin B1 appears to relieve dysmenorrheal in cases of vitamin B1 deficiency. It is not known whether supplementing would relieve the condition in women who are not deficient.

In a double-blind trial, adolescents living in India who were suffering from dysmenorrhea took 100 mg of vitamin B1 (thiamine) per day for three months. Eighty-seven percent of those treated experienced marked relief of dysmenorrhea symptoms.47 However, vitamin B1 deficiency is relatively common in India, whereas it is rare in the Western world, except among alcoholics. It is not known whether vitamin B1 supplementation would relieve dysmenorrhea in women who are not B1 deficient.

1 Star

Vitamin D

Refer to label instructions

In a double-blind trial, women with dysmenorrhea received a placebo or a single administration of a large amount of vitamin D, which appeared to significantly diminish menstrual pain. This should only be done under doctor supervision.

In a double-blind trial, women with dysmenorrhea received a placebo or a single administration of a large amount of vitamin D (300,000), five days before the expected onset of the next menstrual period. During the next two menstrual periods, menstrual pain was significantly lower in the vitamin D group than in the placebo group.48 Such a large amount of vitamin D should be given only under the supervision of a doctor. Further research is needed to determine whether daily supplementation of a smaller amount (such as 800 to 2,000 IU per day) would have a similar beneficial effect.

1 Star

Vitex

Refer to label instructions

Clinical reports from Germany have suggested that vitex may help relieve different menstrual abnormalities associated with premenstrual syndrome, including dysmenorrhea.

Clinical reports from Germany have suggested that vitex may help relieve different menstrual abnormalities associated with premenstrual syndrome, including dysmenorrhea.49 These studies used 40 drops of a liquid preparation that delivers the equivalent of 40 mg of the dried berries of the plant.

The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2015.

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